Federal cuts to home health care will hurt seniors: John Breaux and Billy Tauzin

Amid the political wrangling going on in Washing­ton over how we fund the federal government, there are other policy proposals under consideration that receive less attention but still stand to deeply impact many Americans.

The government agency that oversees Medicare has proposed across-the-board cuts to home health care payments, which are today confronting the 3.5 million seniors — including 78,000 Louisiana patients — who receive skilled home health care services each year.

On the heels of funding reductions totaling 22 per­cent since 2009, which amount to $72.5 billion over 10 years, Medicare home health payments are again on the chopping block. The Centers for Medicare and Medic­aid Services, or CMS, is proposing to “rebase” home health funding at a rate set at the maximum level allowed by law, in addition to a host of other revenue cutting changes.

Analyses show these cuts will result in a 14 percent overall reduction to Medicare home health payments. Such drastic cuts will cause 47 out of 50 states, including Louisiana, to soon have negative Medicare margins. Across Louisiana, nearly 60 percent of all home health agencies will be operating at a net loss by 2017.

In total, when coupled with cuts already underway, Medicare home health will experience $100 billion in cuts over 10 years. That equals more than $11 billion in lost funding in Louisiana alone.

The Affordable Care Act grants the secretary of Health and Human Services broad discretionary authority and, importantly, does not mandate that home health reimbursement be cut.

To the contrary, the rebasing provision directs that a comprehensive and cumulative analysis be undertaken to ensure that any changes made are appropriate and provide for continued patient access to quality services.

It appears that CMS has elected not to undertake such an analysis, however.

CMS has a host of government resources at its fingertips to make the best possible decisions for the health of American seniors. Unfortunately, CMS may not have fully used these resources when crafting this important draft regulation. For example, the data analysis conducted for this rule is limited to just one year, 2014, even though the cut it proposes is to be implemented in each of the years from 2014 to 2017.

Only through use of all available data and a multi-year impact analysis can there be the needed confidence that this proposed regulation will not undermine the “continued access to quality services” that seniors are guaranteed under Medicare law.

Federal lawmakers and patient advocates are taking notice.

Recently, Louisiana Sen. Mary Landrieu, acting as chairwoman of the Senate Committee on Small Business and Entrepreneurship, sent a letter to the CMS expressing concern for the proposed 14 percent cut to Medicare home health.

Similarly, a bipartisan group of 142 members of Congress recently sent a letter to CMS urging a more complete analysis of the proposed rule as well as its impact on beneficiaries and small businesses.

In September, the U.S. Small Business Administration expressed similar concerns in a letter to CMS that the proposed rule underestimates the impact the rebasing cuts will have on the nation’s small home health agencies.

Advocates for senior citizens including AARP as well as organizations representing physicians, nurses and veterans also have spoken out publicly about the impact of such deeps cuts on the nation’s vulnerable home health patient population.

The value of home health care to the Medicare program cannot be understated. As more seniors require care, we must be poised to provide the most clinically effective care in the most cost effective setting. As the Obama administration and Congress work toward improving health care delivery in America, home health care must be supported — not abated.

We urge the administration to heed the advice of policy makers and community leaders. We applaud those lawmakers — such as Sen. Landrieu — who have taken a stand for home health.

A more complete review of this rule must be completed before deep cuts compromise the delivery of home health to our growing population of seniors who want to be cared for at home.

John Breaux was a U.S. senator from Louisiana and a member of the House of Representatives. Billy Tauzin served in the U.S. House of Representatives representing Louisiana’s 3rd Congressional District.

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